Montana governor wants single-payer, too

Add Montana Governor Brian Schweitzer to the short [so far] list of state leaders who think single-payer health care is the way to go in their states. According to the Progress Report, on Sept. 28, Schweitzer announced his intent to set up his own universal health care system in Montana, modeled after the single payer system in Canada.

Gov. Brian Schweitzer said he will ask the U.S. government to let Montana set up its own universal health care program, taking his rhetorical fight over health care to another level. The popular second-term Democrat would like to create a state-run system that borrows from the program used in Saskatchewan. He said the Canadian province controls cost by negotiating drug prices and limiting non-emergency procedures such as MRIs.

No fan of the PPACA health reform law passed by Congress in 2010, [Schweitzer has been quoted as calling that law “a pack of crap that gives away far too much to the pharmaceutical industry”], Schweitzer wants to tailor his plan to the demographics and economics of his state.

Under his plan, Montana citizens with private insurance could keep it or drop it if they choose and buy into the state-run plan at a cheaper rate. He envisions a system that would cover, with co-pays for service, all the uninsured in Montana.

To get what they want, Schweitzer, Shumlin—and any other governors hoping to create state-specific, single-payer programs—will have to get a waiver from the federal government that would exempt their states from the requirements of PPACA. The Obama administration has said that it’s willing to grant waivers as a way of encouraging innovations health-care delivery. But, under current rules, waivers would begin to become available in 2017—which seems a long way off, especially if your state has a high percentage of uninsured citizens. Vermont is asking to move the start of waivers to 2014, but it’s not clear, yet, whether that move will succeed.

One thing we do know is that Canada’s single-payer healthcare program got its own start in the province of Saskatchewan [whose demographics, says Schweitzer, are similar to those of Montana], and spread province-by-province, until the system went national. Perhaps a similar state-by-state strategy could ultimately bring single payer health care to all of the U.S., as well. And, perhaps, that’s what Schweitzer and Shumlin are envisioning.

One has to applaud both of these governors for their courageous and enlightened approaches to improving the quality of health and life for their citizens. It’s very heartening to see that the single-payer concept is still on the table. And maybe success in a few individual states will inspire other civic-minded state leaders to shed their irrational and hypocritical fears of “socialistic” programs and get on board. I sincerely hope they do, and, at the moment, I’ll cheer for any incremental steps that might help us move toward a national single-payer system.

Still, for this writer, a state-by-state approach is not as good as a national, Medicare for everyone plan. The incremental trajectory of going one state at a time is risky. There’s no guarantee that all states would ultimately adopt single-payer healthcare structures. And that would mean that where you happen to live would affect the cost and quality of your healthcare. And, while I’d like to think that both Governor Shumlin and Governor Schweitzer are proposing single-payer plans for the best interest of the citizens of their states, one must remember that other governors may see the chance to opt out of PPACA as convenient subterfuge for asserting a states’-rights agenda while undermining any effort at creating a sane, uniform, nationwide healthcare policy. We’ve seen states’ rights at work before, and it’s not pretty. We need to remind ourselves of the dysfunction and fundamental inequalities created by a free-for-all patchwork of state policies on voting rights, racial integration, reproductive rights and economic assistance.

State-specific, single-payer healthcare plans could work and eventually go viral, and that could be a good thing that I would cheer for. But let’s go into this with our eyes open.